Ta Ta Tansen

Almost 5 months in Nepal has quickly come and went.  We just finished eating at the Lazy Gringo in Kathmandu.  We have come full circle, as this is the first place we ate upon arriving in Nepal.  Lots of dal bhat (rice and lentils) bookended with chimichangas.  The bags are ready and we soon board a plane for Africa.  The Lord has blessed our family with health, safety, good friends, and plenty of work to do during our time at Tansen.

 

Andrea found herself busy at the hospital 3 half days per week working with the children.  This included playing with children, working with pastoral care, and providing distraction during painful procedures.  While at Tansen, Andrea taught 3 classes on child friendly approaches to the pediatric patient, including lecturing to an auditorium of over 80 nursing students.  Teaming up with Pernilla Ardeby, a pediatric nurse from Sweden, Andrea wrote a chapter on emotional support and distraction for the pediatric patient.  This is soon to be published and adopted nation wide for the pediatric nursing curriculum. 

    

It has been a productive time in terms of orthopaedics.  In 4 months at Tansen Mission Hospital I have operated on over 250 patients.  We worked 6 days a week at the hospital, Sunday-Friday.  I had clinic 1-2 days per week where with a single resident we would see 60-100 patients per day.  The efficiency and hard work of the clinic and operating theatre staff make this possible.  About half of the operated patients were pediatric.  73 of the patients operated were pediatric patients with elbow fractures of every kind.  12 patients got 13 intramedullary SIGN nails for femur and tibia fractures.  After assisting a number of cesarean sections, 8 patients had orthopaedic C-sections for fetal distress and breech presentation, as this is part of surgical call.   Dr. Dipak and Dr. Tul were able to take some well-deserved breaks.

SIGN Nail

Open fractures treated with provisional external-fixation, now for SIGN nail

Being here for some months has allowed me to see many of our follow-ups.  In an earlier blog post I mentioned a horrible accident involving a bus going over a cliff in which many people were killed and 17 badly injured patients were brought to our hospital over 30 minutes.  With the treacherous roads This is not an uncommon event here and the Tansen triage ran smoothly as usual.  One of the patients had a bad pelvic fracture.  After consulting and crafting an operative plan with Dr. Peter Cole we operated on this mans pelvis including placing percutaneous sacroiliac screws which had not been done at Tansen before.  At 10 weeks from surgery he is in no pain, happy, and ready to get back to work so he can support his family. 

                       

I owe a huge thanks to Dr. Dipak Maharjan, Dr. Tul Bdr Pun, and the lovely patients of Nepal for giving me a fellowship of orthopaedics in the tropical developing setting.  They gave me experienced instruction on how to address tuberculosis of the spine, hip, knee, and ankle.  They also helped me diagnose and treat pyomyositis, acute and chronic pediatric osteomyelitis the likes of which I have never seen.   Dr. Anod’s surgical approach to pediatric supracondylar elbow fractures I will always take with me.

The moments that will be forever with us stem from sharing Christ’s love with our Nepali friends and patients.  Through our daily work, devotions, and worship we have had much treasured fellowship.

  

Cooking with small spoon at ortho Christmas party

 Despite it being December in the mountains and not having heat our family is feeling warm.  We had a wonderful visit from Andrea’s mom, Diane, and Uncle Gary.  They brought us a new drill!  Instead of snow there are poinsettia trees.  The past weeks have been filled with Advent and Christmas celebrations with the Nepali and mission community.  Our Tansen Men’s Barbershop Choir performed White Christmas and Silent Night at a couple of them.  We are blessed to have been a part of and supported by the Tansen community.  It has been home to us and we are sad to go.

Poinsettia

Mom and Uncle Gary playing with Tansen patients

Beginning of 10 hour bus ride to Kathmandu.  No whahka whahka yet (vomit).

We have been blessed by the safe arrival of the SIGN nail sets sponsored by Dr. Ebeling and Dr. Esterberg which will be the first program in Zimbabwe.  Please see our earlier post on SIGN nail if interested (www.signfracturecare.org).  This equipment was shipped by Orphan Grain Train on a large shipping container which made the 4 month journey from Nebraska to Karanda.  Currently having some difficulty with the Zimbabwe medical license, but trust that all will work out as it is meant to.  

Merry Christmas and Happy Holidays!

Andrea, Ryan, & Winslow Horazdovsky

Thank You

“Back Home” we have a problem

We wanted to write a thank you to all the people who have been supporting us from “Back Home” in the States.  Without your prayers and support our work here would not be possible.  Needs come up that are impossible for us to deal with on our own from Nepal.  Thankfully, every time we have needed something, God has provided family and friends back home to help.

A special thanks to:

Our families. 

My family has kept us in the loop and been there when I couldn’t be as my Grandma Sally fell ill and then passed away a few days ago.  It is really hard for us not to be there.  Kelly and Mom are always there for us.  Without my brother, Kyle, I would not have been able to organize my medical license for our upcoming trip to Zimbabwe.  My dad has helped with banking problems that could not be sorted from overseas.  Reid and Lindsey for “Clifford the Big Red Dog,” and other fun things for Win.

My in-laws, Tom, Diane, Natalie, and Gina, who have helped us in so many ways.  Draining and fixing hot tubs in freezing weather with my uncle Dave.  Picking up and dropping things all over town.  Thoughtful packages to lift our spirits.  Paying doctors and insurance bills that come in 3 months after we’ve left.  Now running at the last minute to organize a drill that Diane will bring to us to use during surgery on patients here in Nepal.  Means so much to have you guys behind us.

Packages for us and folks at the hospital from: Erin Obrien, Reid & Lindsey, Stephanie Labouliere, Diane, and Kelly Kramper.  Dr. Pete Sanders for sending lectures to help organize a musculoskeletal curriculum for the residents here at Tansen.

Surgical advice and help from Dr. Matt Putnam, Dr. Ann Van Heest, Dr. Peter Cole, Dr. Brad Nelson, Dr. Pat Yoon, Dr. Jonathan Witzke, Dr. Zirkle at SIGN.

Lance Ohara, the Bergers, Dave Stoy, and our neighbors, the Bruno’s, for letting us not have to worry about our home while we are gone.

Bill and Dan at Arthrex for providing a tendon harvester and suture anchors.

Martha Fick and The Good Samaritan Society, Karen Mangels and Orphan Grain Train, and the many good folks at SIGN.

Besty Wehrwein, Dr. Gordy Aamoth,  and the Minnesota Medical Foundation International Scholarship.  Laura Berkstesser and the good people at Samaritan’s Purse.

Dr. David Hightower for lining up some work for me when I get back.

Dr. Jim Lebret for medical consultation for my family.  Dr Keenan and Zanfes for travel consults.

This list is not complete.  Thank you to everyone else whom we have forgotten. We could not be here without you.

 Also, today we are celebrating Ryan's 33rd Birthday!!! Happy Birthday, Ryan!!

Yoon Visit

We had a visitor, Dr. Patrick Yoon, out with us the past couple weeks in Tansen.  Pat is a good friend and one of my instructors from orthopaedic residency.  He works at our busy level one trauma center, HCMC, specializing in orthopaedic trauma, adult reconstruction, and foot & ankle.  

We had plenty of work to do while he was here.  Before his arrival we had one talus (ankle bone) fracture over two and half months – upon his arrival we had 3 tough talus fractures and one calcaneus (heel bone) fracture in one week.  It was a mini foot and ankle trauma fellowship for the Nepali orthopaedic surgeon, Dr. Tul and myself.

The rain of pediatric elbow and wrist fractures continues – helped along by huge swings built out of bamboo trees in every village in celebration of the Desai Hindu holiday.   We have been seeing many patients with tough soft tissue coverage issues as well.  This busy week of surgery was made possible by the great OR staff at Tansen who turn over the rooms and have the next patient ready in 10-15 

minutes.

We were able to help a young woman with badly deformed and painful wrists after sustaining fractures that were neglected a year ago.  She was pregnant when she had these fractures and now has two small children.  Her husband is not currently in the picture and may not be for some time.  The pastoral care team at Tansen helped put together a plan to care for the children while she would be recovering from surgery.   I am very thankful to have had the ability to call upon the experience and wisdom of my many of my surgery instructors back in Minnesota when I have had patients with difficult problems here in Nepal.  On this occasion Dr. Matt Putnam helped us craft a surgical plan to take care of this woman’s wrist.  We made a biplanar osteotomy (cut) in her forearm bone with a drill and chisel.  Then we took a piece of bone from her pelvis and wedged into the gap to restore proper wrist alignment.  If things go well we will fix the other side before Christmas.

In addition to fixing broken bones, Pat also acted as baby clothes mule filling half of his luggage with items for Win.  This earned Pat a number of big hugs from Win as he was getting ready to leave.  We were able to make some beautiful treks around Tansen and again when we took a few days for relaxation in Pokhara.  Big thanks to Dr. Yoon for the energy and teaching he brought to Nepal the past couple weeks!